iCAN (Canyons Academy North) Application Form
** IMPORTANT: We have been able to secure a LIMITED number of additional spaces in the iCAN Academy.  The application is now reopen**

A lottery will be held if necessary.

All information on this form is CONFIDENTIAL.

The new application deadline is June 15th, 2020

Non-Discrimination Statement:

The William S. Hart Union High School District prohibits unlawful discrimination against and/or harassment of any student, employee or job applicant on the basis of actual or perceived race, color, ethnicity, national origin, immigration status, ancestry, religion, age, marital status, pregnancy, parental status, physical or mental disability, medical condition, military or veteran status, political affiliation, sex, gender, gender identity, gender expression, genetic information, sexual orientation, or any other basis prohibited by state and federal nondiscrimination laws respectively at any District site and/or activity.  All inquiries regarding discrimination, civil rights, and/or Title IX should be directed to the Director of Human Resources, William S. Hart Union High School District, 21380 Centre Pointe Pkwy, Santa Clarita, CA 91350, or by phone (661) 259-0033, or by email: UCP@hartdistrict.org
Email *
Student's Last Name *
2. Student's LEGAL First Name *
3. Student LEGAL Middle Name *
4. Birthdate (mm/dd/yyyy) *
MM
/
DD
/
YYYY
Student's Current Grade (19/20 school year)
Is the student enrolled at Castaic High School? (enrollment is required before iCAN application will be considered) *
5. Current Junior High School/High School *
6. Hart District School ID # (Enter NONE if you are a non-district student) *
7. Does the student have a 504 Plan? *
8. Does the student have an IEP? *
Student's current GPA (verification may be requested) *
Why does the student want to enroll in the iCAN Academy? *
9. Primary address where student resides (Street number with apt/space number) *
10. City *
11. Zip Code *
12. Home Phone Number (xxx-xxx-xxxx) *
13. (1) Name of Parent/Guardian *
14. Parent/Guardian Address (Note same as student or or add if different than student) *
15. Cell Phone Number (xxx-xxx-xxxx) *
17. Parent Email Address *
18. (2) Name of Parent/Guardian
19. (2) Parent/Guardian's Address (Note same as student or add if different than student)
20.(2) Parent/Guardian's Cell Phone Number (xxx-xxx-xxxx)
A copy of your responses will be emailed to the address you provided.
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